Coronary Wave Intensity Analysis as an Invasive and Vessel-Specific Index of Myocardial Viability

Area of Science:

• Cardiology
• Cardiovascular Physiology
• Diagnostic Imaging

Background:

• Ischemic cardiomyopathy diagnosis relies on coronary angiography and viability testing, often requiring separate procedures.
• Current methods lack a single test for both coronary physiology and myocardial viability assessment.
• Coronary wave intensity analysis (CWIA) interrogates myocardial contractility and microvascular function.

Purpose of the Study:

• To evaluate CWIA's accuracy in predicting myocardial viability compared to late-gadolinium-enhanced cardiac magnetic resonance imaging (LGE-CMR).
• To determine if CWIA can serve as a single diagnostic tool for ischemic cardiomyopathy.

Main Methods:

• Patients with LVEF ≤40% and extensive coronary disease underwent CWIA during cardiac catheterization (rest, hyperemia, dobutamine stress).
• A dual pressure-Doppler sensing coronary guidewire was used for CWIA.
• Myocardial viability was assessed by LGE-CMR and functional recovery via echocardiography at 6-month follow-up.

Main Results:

• Resting backward compression wave energy in viable territories was significantly greater than in nonviable ones (P<0.001).
• CWIA demonstrated comparable accuracy to LGE-CMR in predicting viability (AUC 0.812 vs. 0.757).
• A threshold of -2500 W m⁻² s⁻¹ for backward compression wave energy yielded 86% sensitivity and 76% specificity.

Conclusions:

• Backward compression wave energy measured by CWIA accurately predicts myocardial viability, similar to LGE-CMR.
• CWIA offers potential to simplify ischemic cardiomyopathy management, akin to FFR's impact on stable angina.